Healthcare Provider Details

I. General information

NPI: 1679260616
Provider Name (Legal Business Name): SUANUR ALP MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 RIVERSIDE AVE
MINNEAPOLIS MN
55454-1450
US

IV. Provider business mailing address

2450 RIVERSIDE AVE M136, 1ST FLOOR, EAST BUILDING 8950A
MINNEAPOLIS MN
55454
US

V. Phone/Fax

Practice location:
  • Phone: 612-624-4477
  • Fax:
Mailing address:
  • Phone: 612-624-4477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number87558-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: